(Amended by Ordinance No. 173369, effective May 12,
1999.) Hold harmless agreements required by subdivisions C and D of
Section 5.08.160 shall be in the following form:
WHEREAS there was due and
owing by the City of Portland, Oregon, to
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . .who died . . . . . . . . . . . . . .. . . . , 19 . . . . , the sum of $ .
. . . . . . . . . . . . .representing . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . and the Auditor of the City of Portland holds said sum in the form
of checks drawn payable to the said deceased; and
WHEREAS there will
be no probate of the decedent’s estate and I, as . . . . . . . . . . . . . . .
. . . . . . . . (heir, next of kin) of the deceased, have applied to the
Auditor of the City of Portland for delivery of these checks according to the
provisions of Title 5 of the Portland Municipal Code, as amended, whereby the
Auditor may deliver these checks to me, as . . . . . . . . . . . . . . . . . .
. . . , (heir, next of kin) only upon condition that I first release and
discharge the City of Portland, its officers, agents and employees from all
liability with respect to delivery of these checks and payment thereof, and
agree to defend and indemnify the City of Portland, its officers, agents and
employees therefrom;
NOW, THEREFORE, in
consideration of the payment to me of said sum, I hereby release and discharge
the City of Portland, its officers, agents and employees from all liability
arising from or consequent upon the payment to me of said sum and I hereby
assume and agree to and with said City, its officers, agents and employees
that I will defend and indemnify them against any claim, suit, action or
judgment in consequence of the delivery of checks for, or payment of, said
sum.
IN WITNESS WHEREOF,
I have hereunto set my hand and seal this
. . . . . . . day of . . . . . . . . . . . . . , 19 .
. . .
. . . . . . . . . . . . . . . . .(SEAL)
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. . . .
Address
WITNESS:
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Address
